Frequency and determinants of ocular trauma in the Kimpese Rural Health Zone, Kongo Central, Democratic Republic of Congo: Fréquence et Déterminants des traumatismes oculaires dans la Zone de santé de Kimpese, Kongo Central, RDC

Context and objective. Ocular trauma is very common and its etiological factors vary by region and age group. This study aims to describe the magnitude and determinants of ocular trauma complications in rural areas.  Methods. We conducted a retrospective study of patients admitted for ocular trauma at Kimpese Hospital between January 2014 and December 2016. Univariate logistic regression was used to assess the determinants of ocular trauma complications. The statistical significance level is p˂ 0.05.  Results. A total of 223 patients were included. The majority of participants were men (69.5%), over 18 years of age (70%), with poor visual acuity (57.8%) and bilateral ocular involvement (51.1%). Plant objects (44.8%) and metal objects (15.2%) were the most common traumatic agents. After treatment, an improvement in visual acuity was observed in 64.3% of patients with previously poor visual acuity (p < 0.001). The delay of care > 7 days [aOR: 2.286 (95% CI: 1.302-4.012), p=0.004] and the poor visual acuity on admission [aOR: 5.906 (95% CI: 3.231-10.796), p< 0.0001] emerged as determinants of the onset of complications. Conclusion. Awareness-raising efforts for early consultation after ocular trauma and integration of eye care at the primary level should be promoted for efficiency in care. Contexte et objectifs. Les traumatismes oculaires sont très fréquents et ses facteurs étiologiques varient selon les régions et les tranches d’âge. Cette étude a pour objectifs de décrire le fardeau et rechercher les déterminants des complications des traumatismes oculaires en milieu rural. Méthodes. Nous avons mené une étude documentaire sur les patients admis à l’hopital de Kimpese pour un traumatisme oculaire entre janvier 2014 et décembre 2016. La régression logistique univariée a été utilisée pour rechercher les déterminants des complications des traumatismes oculaires. Le seuil de signification statistique est p˂0.05. Résultats. La majorité des participants était des hommes (69,5%), de la tranche de plus de 18 ans (70 %), avec une mauvaise acuité visuelle (57,8%) et une atteinte oculaire bilatérale (51,1%). Les objets de nature végétale (44,8%) et les objets métalliques (15,2%) ont constitué les agents traumatiques les plus rencontrés. Après traitement, une amélioration de l’acuité visuelle a été constatée chez 64,3% des patients ayant précédemment une acuité visuelle mauvaise (p< 0,001). Le délai de prise en charge > 7 jours [ORa : 2 ,286 (IC 95% : 1,302-4,012), p= 0,004] et la mauvaise acuité visuelle à l’admission [ORa : 5,906 (IC 95%: 3,231-10,796), p < 0,0001] ont émergé comme déterminants de la survenue des complications. Conclusion. Les efforts de sensibilisation en faveur de la consultation précoce après les traumatismes oculaires et une intégration des soins oculaires au niveau primaire sont à promouvoir pour une efficience dans la prise en charge

Effect of a control project on clinical profiles and outcomes in buruli ulcer: a before/after study in Bas-Congo, Democratic Republic of Congo.

BACKGROUND: Buruli ulcer (BU) is a necrotizing bacterial infection of skin, subcutaneous tissue and bone caused by Mycobacterium ulcerans. Although the functional impairment caused by BU results in severe suffering and in socio-economic problems, the disease remains largely neglected in Africa. The province of Bas-Congo in Democratic Republic of Congo contains one of the most important BU foci of the country, i.e. the Songololo Territory in the District of Cataractes. This study aims to assess the impact of a BU control project launched in 2004 in the Songololo Territory. METHODS: We used a comparative non-randomized study design, comparing clinical profiles and outcomes of the group of patients admitted at the General Reference Hospital (GRH) of the "Institut Médical Evangélique" (IME) of Kimpese 3 years before the start of the project (2002-2004) with those admitted during the 3 years after the start of the project (2005-2007). RESULTS: The BU control project was associated with a strong increase in the number of admitted BU cases at the GRH of IME/Kimpese and a fundamental change in the profile of those patients; more female patients presented with BU, the proportion of relapse cases amongst all admissions reduced, the proportion of early lesions and simple ulcerative forms increased, more patients healed without complications and the case fatality rate decreased substantially. The median duration since the onset of first symptoms however remained high, as well as the proportion of patients with osteomyelitis or limitations of joint movement, suggesting that the diagnostic delay remains substantial. CONCLUSION: Implementing a specialized program for BU may be effective in improving clinical profiles and outcomes in BU. Despite these encouraging results, our study highlights the need of considering new strategies to better improve BU control in a low resources setting

The clinico-epidemiological features of BU patients at admission in IME/Kimpese Hospital.

<p>*Fisher exact test (An expected cell value is less than 5).</p

Single ulcerative lesion <5 cm diameter (confirmed by IS<i>2404</i>-PCR).

<p>Single ulcerative lesion <5 cm diameter (confirmed by IS<i>2404</i>-PCR).</p

Healed lesion without complication after antibiotherapy alone without surgery.

<p>Healed lesion without complication after antibiotherapy alone without surgery.</p

Results of the management of BU patients in IME/Kimpese Hospital.

*<p>Fisher exact test (An expected cell value is less than 5).</p

A simple ulcerated form of disease on the right arm.

<p>A simple ulcerated form of disease on the right arm.</p

Burden of <i>Mycobacterium ulcerans</i> Disease (Buruli Ulcer) and the Underreporting Ratio in the Territory of Songololo, Democratic Republic of Congo

<div><p>Background</p><p>Cutaneous infection by <i>Mycobacterium ulcerans</i>, also known as Buruli ulcer (BU), represents the third most common mycobacterial disease in the world after tuberculosis and leprosy. Data on the burden of BU disease in the Democratic Republic of Congo are scanty. This study aimed to estimate the prevalence rate and the distribution of BU in the Songololo Territory, and to assess the coverage of the existing hospital-based reporting system.</p><p>Methods</p><p>We conducted a cross-sectional survey (July–August 2008) using the door-to-door method simultaneously in the two rural health zones (RHZ) of the Songololo Territory (RHZ of Kimpese and Nsona-Mpangu), each containing twenty health areas. Cases were defined clinically as active BU and inactive BU in accordance with WHO-case definitions.</p><p>Results</p><p>We detected 775 BU patients (259 active and 516 inactive) in a total population of 237,418 inhabitants. The overall prevalence of BU in Songololo Territory was 3.3/1000 inhabitants, varying from 0 to 27.5/1000 between health areas. Of the 259 patients with active BU, 18 (7%) had been reported in the hospital-based reporting system at Kimpese in the 6–8 months prior to the survey.</p><p>Conclusion</p><p>The survey demonstrated a huge variation of prevalence between health areas in Songololo Territory and gross underreporting of BU cases in the hospital-based reporting system. Data obtained may contribute to better targeted and improved BU control interventions, and serve as a baseline for future assessments of the control program.</p></div

Distribution of total number of BU cases (active and inactive) in the Songololo Territory, July–August 2008.

<p>Distribution of total number of BU cases (active and inactive) in the Songololo Territory, July–August 2008.</p

Prevalence of Buruli ulcer disease in Africa.

<p>BU: Buruli ulcer.</p